{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T11:13:58Z","timestamp":1792840438622,"version":"4.5.0"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T00:00:00Z","timestamp":1776816000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Primary membranous nephropathy (MN) is an autoimmune kidney disease, and the main autoantibody is directed against the M-type phospholipase A2 receptor (PLA2R). Approximately 20-40% of patients with MN do not respond to standard immunosuppressive therapy, termed refractory MN. Previous studies suggest obinutuzumab\u2019s efficacy in refractory MN, but the optimal dosing regimen remains undefined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single-center retrospective study investigated the efficacy and safety of a B-cell reconstitution-guided regimen of obinutuzumab in patients with refractory MN. All patients were followed at 3-month intervals for up to 18 months. The primary outcome was a composite of complete or partial remission. The secondary outcomes included complete remission, B-cell depletion, immunological remission, and safety profiles.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 33 patients with refractory MN were included (81.8% were rituximab-refractory), with a mean age of 46.1\u00a0\u00b1\u00a012.1 years. At baseline, these patients had a mean 24-hour urinary protein of 6.7\u00a0\u00b1\u00a04.9 g, a mean serum albumin of 30.0\u00a0\u00b1\u00a08.3 g\/L, and positive anti-PLA2R in 19 (57.6%) cases. The median total obinutuzumab dose was 2\u00a0g (IQR: 2-3). Following treatment, the cumulative remission rate during the 18-month follow-up period reached 84.8%. B cells were depleted in all patients at month 3, and the median duration of sustained B-cell depletion was 12 months (95% CI: 9.5-14.5). Among the 19 anti-PLA2R-positive patients, 84.2% achieved immunological remission at month 18. No patients experienced severe adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study demonstrates that B-cell reconstitution-guided modified-dose obinutuzumab is associated with favorable efficacy and a safety profile in refractory MN. The individualized strategy minimized drug exposure while maintaining efficacy, but the conclusions warrant further validation in controlled studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1787013","type":"journal-article","created":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T05:47:20Z","timestamp":1776836840000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Efficacy and safety of modified-dose obinutuzumab in the treatment of refractory membranous nephropathy"],"prefix":"10.3389","volume":"17","author":[{"given":"Jiannan","family":"Zhou","sequence":"first","affiliation":[{"name":"Department of Nephrology, Beijing Aerospace General Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanxi","family":"Ai","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Zhang","sequence":"additional","affiliation":[{"name":"Renal Division, Department of Medicine, Peking University First Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Beijing Aerospace General Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gang","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiping","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Nephrology, 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